| NPI | 1295443612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0032461) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209030481) |
| 363LF0000X Nurse Practitioner, Family (Licence: IN 71015724A) | |
| Enumeration Date | 2022-11-15 |
| Last Update Date | 2024-10-15 |